Choice and Consequences in the Medicare Part D Plan

描述（由申请人提供）：2003年的《医疗保险现代化法案》，更广为人知的是将D部分处方药福利加入医疗保险计划的立法，代表了美国过去40年来最重要的公共保险计划的扩张。也许这项立法最新颖、最具争议的特点是使用多个私人保险提供商来提供这种新的公共保险产品，价格和产品特征各不相同（包括甜甜圈洞，即个人可以支付初始药物支出，但不包括更高水平的支出）。我将使用一个独特的数据集来评估D部分的效果，该数据集允许我在2005年至2009年期间跟踪数百万老年人，包括他们的处方药覆盖范围和他们选择的D部分计划的数据。特别地，这个项目旨在回答六个问题。首先，老年人在选择D部分计划时面临的财务风险是什么？在他们的国家，选择替代计划的财务后果是什么？其次，老年人是否选择了D部分计划，以最大限度地减少处方药覆盖的总成本，如果不是，他们的选择会让他们损失多少钱？第三，是什么决定了D部分计划的选择？我将估计一个计划选择的综合计量经济模型，以评估财务和非财务因素在驱动选择中的作用。第四，是什么决定了计划选择的动态性；如果个人选择了一个不合适的计划，他们会重新优化吗？还是在计划选择上有很强的惯性？第五，D部分计划的结构如何影响利用率？这些纵向数据，以及由计划选择中的惯性提供的潜在计量经济识别，将允许我开发利用弹性的估计。最后，处方药的使用如何应对年内费用分担的变化？了解个人是否预见到甜甜圈洞，以及他们对这一特征的反应，对于对D部分福利结构的改革建模至关重要。这些分析的结果将首次全面说明D部分的选择是如何做出的，以及这些选择如何影响受益人的药物使用。这些发现应该对政策制定者非常有帮助，因为他们正在考虑对这一主要权利计划进行改革。

DESCRIPTION (provided by applicant): The Medicare Modernization Act of 2003, better known as the legislation that added the Part D prescription drug benefit to the Medicare program, represents the single most significant expansion of public insurance programs in the U.S. in the past 40 years. Perhaps the most novel, and controversial, feature of this legislation was the use of multiple private insurance providers to deliver this new public insurance product, with widely varying prices and product features (including the donut hole whereby individuals are covered for initial drug expenditures but not for higher levels of expenditures). I will evaluate the effects of Part D using a unique data set that allows me to follow several million elders over the 2005 to 2009 period, with data on both their prescription drug coverage and their choice of Part D plan. In particular, this project aims to answer six questions. First, what is the financial risk facing elder when choosing their Part D plans; what are the financial consequences of alternative plan choices in their county? Second, are elders choosing the part D plan that minimizes their total cost of prescription drug coverage, and, if not, how much money are they leaving on the table through their choices? Third, what determines choice of Part D plan? I will estimate a comprehensive econometric model of plan choice to assess the role of financial and non-financial factors in driving choices. Fourth, what determines the dynamics of plan choice; do individuals re-optimize if they have chosen an inappropriate plan or is there very strong inertia in plan choice? Fifth, how does the structure of Part D plans affect utilization? These longitudinal data, and the potential econometric identification that is provided by inertia in plan choice, will allow me to develop estimates of utilization elasticity. Finally, how does prescription drug use respond to within-year changes in cost-sharing? Understanding whether individuals anticipate the donut hole, and how they react to this feature, is critical for modeling reforms to the Part D benefit structure. The result of these analyses will be the first comprehensive picture of how Part D choices are made, and how those choices impact beneficiary drug utilization. These findings should be very helpful to policy- makers as they consider ongoing reforms of this major entitlement program. The Medicare Modernization Act of 2003, better known as the legislation that added the Part D prescription drug benefit to the Medicare program, represents the single most significant expansion of public insurance programs in the U.S. in the past 40 years. Perhaps the most novel, and controversial, feature of this legislation was the use of multiple private insurance providers to deliver this new public insurance product, with widely varying prices and product features (including the donut hole whereby individuals are covered for initial drug expenditures but not for higher levels of expenditures). I will provide the first comprehensive picture of how Part D choices are made, and how those choices impact beneficiary drug utilization. These findings should be very helpful to policy-makers as they consider ongoing reforms of this major entitlement program.